Climate change and associated sea level rise (SLR) are already impacting low-lying coastal areas, including islands, throughout the world. Many of these areas are inhabited, many will need to be abandoned in coming decades as SLR continues. We examine the evolution (1850-2013) of the last inhabited offshore island in Virginia waters of Chesapeake Bay USA, the Tangier Islands. Three SLR scenarios, a low, mid, and high, were considered. Since 1850, 66.75% of the islands landmass has been lost. Under the mid-range SLR scenario, much of the remaining landmass is expected to be lost in the next 50 years and the Town will likely need to be abandoned. The high SLR scenario will accelerate the land loss and subsidence, such that the Town may need to be abandoned in as few as 25 years. We propose a conceptual plan that would significantly extend the lifespan of the islands and Town.